Basic Information
| Provider Information | |||||||||
| NPI: | 1598900565 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PANKRATZ | ||||||||
| FirstName: | KRISTEN | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4872 HILO CIR | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926492365 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7146208131 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 12800 GARDEN GROVE BLVD | ||||||||
| Address2: | #F | ||||||||
| City: | GARDEN GROVE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928432008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7146208131 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2008 | ||||||||
| LastUpdateDate: | 12/04/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.